Académique Documents
Professionnel Documents
Culture Documents
MILESTONES
CHART
Developed by
The Institute for Human Services for
The Ohio Child Welfare Training
Program
July 2008
Overview:
How To Use:
Cognitive
12 mo: beginning of
symbolic thinking;
points to pictures in
books in response to
verbal cue; object
permanence; some
may use single words;
receptive language
more advanced than
expressive language
15 mo: learns through
imitating complex
behaviors; knows
objects are used for
specific purposes
2 yrs: 2 word phrases;
uses more complex
toys and understands
sequence of putting
toys, puzzles together
Social
Attachment: baby
settles when parent
comforts; toddler
seeks comfort from
parent, safe-base
exploration
5 mo: responsive to
social stimuli; facial
expressions of
emotion
9 mo: socially
interactive; plays
games (i.e., pattycake) with
caretakers
11 mo: stranger
anxiety; separation
anxiety; solitary play
2 yr: imitation, parallel
and symbolic, play
Emotional
Preschool
Physical
Physically active
Cognitive
Ego-centric, illogical, magical
thinking
Explosion of vocabulary;
learning syntax, grammar;
Weight gain: 4-5 lbs
understood by 75% of
per year
people by age 3
Growth: 3-4 inches
per year
Physically active,
cant sit still for
long
Clumsy throwing
balls
Refines complex
skills: hopping,
Primitive drawing, cant
jumping,
represent themselves in
climbing,
drawing till age 4
running, ride big
wheels and
Dont realize others have
tricycles
different perspective
Improving fine
Leave out important facts
motor skills and
eye-hand
May misinterpret visual cues of
coordination: cut
emotions
with scissors,
draw shapes
Receptive language better
than expressive till age 4
3 3 yr: most
toilet trained
Social
Play:
Cooperative,
imaginative, may
involve fantasy
and imaginary
friends, takes turns
in games
Develops gross
and fine motor
skills; social skills;
experiment with
social roles;
reduces fears
Wants to please
adults
Development of
conscience:
incorporates
parental
prohibitions; feels
guilty when
disobedient;
simplistic idea of
good and bad
behavior
Curious about his and
others bodies, may
masturbate
No sense of privacy
Primitive, stereotypic
understanding of
gender roles
Emotional
Psycho-social task is identity
formation
Adolescents
Physical
Growth spurt:
Girls: 11-14 yrs
Boys: 13-17 yrs
Emotional
Cognitive
Social
Self-esteem based on
what others tell him
or her
Increasing ability to
Cognitive delays; inability to concentrate
control emotions; less
emotional outbursts
Cannot play cooperatively; lack curiosity, absent
imaginative and fantasy play
Increased frustration
tolerance
Social immaturity: unable to share or negotiate with
peers; overly bossy, aggressive, competitive
Better delay
gratification
Attachment problems: overly clingy, superficial
attachments, show little distress or over-react when
Rudimentary sense of
separated from caregiver
self
Underweight from malnourishment; small stature
Understands concepts
of right and wrong
Excessively fearful, anxious, night terrors
Self-esteem reflects
opinions of
significant others
Curious
Self-directed in many
activities
School Aged
Physical
Emotional
Cognitive
Social
Use language as a
communication tool
Perspective taking:
Understands concepts
5-8 yr: can recognize
of right and wrong
others perspectives,
cant assume the role of Rules relied upon to
the other
guide behavior and
810 yr: recognize
play, and provide
difference between
child with structure
behavior and intent; age
and security
10-11 yr: can accurately
recognize and consider
5-6 yr: believe rules can
others viewpoints
be changed
Concrete operations:
Accurate perception of
events; rational, logical
thought; concrete
thinking; reflect upon self
and attributes;
understands concepts of
space, time, dimension
Can remember events
from months, or years
earlier
More effective coping skills
Understands how his
behavior affects others
Handout #1
WELCOME !!
Module VII
Child Development:
Implications for Family-Centered
Child Protective Services
1
Principles of Development
Ongoing process
Dynamic
Interactive
Directional
Cumulative
Stages
Environment
Heredity
3
Handout #1
Influence of Heredity
Influence of
Environment
Prenatal
Physical
Social/cultural shapes expression
of traits, abilities
Learning environment: need
stimulation
Emotional environment: need
secure, calm
What is Normal?
Handout #1
Developmental Domains
Physical:
Body structure
Sensory development
Motor development
Developmental Domains
Cognitive
Thinking
Perception
Memory
Reasoning
Problem solving
Language
Executive function
8
Developmental Domains
Social:
Handout #1
Developmental Domains
Emotional:
Personal traits
Identity
Self esteem
Mood, affect
10
Stages of
Cognitive Development
Formal Operational
(Adolescence/Adulthood)
Concrete operational
(Elementary/Early Adolescence)
Pre-operational
(Toddler/Early Childhood)
Sensorimotor
(Infancy)
11
Intimacy
vs Isolation
(Young Adult)
Identity vs
Identity Confusion
(Adolescence)
Industry vs Inferiority
(School Age)
Initiative vs Guilt
(Preschool)
Autonomy vs Shame & Doubt
(Toddler)
Trust vs Mistrust
(Infancy)
Erikson, Erik (1968). Identity, Youth & Crisis, New York: Norton.
12
Handout #1
Child Development
Birth to Three Years
Photography:
Judith S. Rycus PhD, MSW
Jeffrey A. Rycus, MA
The Institute for Human Services
Columbus, Ohio
Copyright 1990 All Rights Reserved
13
ATTACHMENT
14
Attachment: 3 Components
Enduring relationship with specific
person
Presence of person provides
security, comfort
Intense distress with loss or threat
of loss of that person
15
Handout #1
ATTACHMENT IS CRITICAL
TO DEVELOPMENT
Trust
Language
Emotion
Social
Self esteem
Security
Autonomy
Cognitive
16
Assessing Attachment
Parent recognizes signs of distress
and intervene?
Parent stimulates child
and initiates playful
interaction?
Parent provides comfort
and closeness?
17
Assessing Attachment
Child seeks proximity to parent?
Child approaches parent for
reassurance, comfort, protection?
Child directly communicates needs?
Child obtains comfort, then returns
to play?
Child and parent enjoy each others
company?
18
Handout #1
Brain Development
21
Handout #1
22
Insecure Attachment
Caused by:
Traumatic separations
Abuse and neglect
23
Attachment Problems
Insecure Attachment
Parent is unresponsive, rejecting,
lacks warmth, avoids physical
contact, is unpredictable, provides
inconsistent care
Disorganized Attachment
Parent is frightening to child
24
Handout #1
Complex Trauma
Chronic maltreatment by parents
or caregivers that begin early in
childhood:
Outcomes: Pervasive
developmental outcomes
across several domains (Cook,
2003)
25
26
Fahlbergs
Arousal/Relaxation Cycle
Child and
Parent Relax
Mutual
Satisfaction
Childs
Need Felt
Building Attachment
Child
Expresses
Need
27
Handout #1
28
Streissguth, 1994
Slide courtesy of Research Society on Alcoholism, Alcohol and Alcohol Actions Lecture Series
http://rsoa.org/lectures/about.html
29
30
10
Handout #1
Slide courtesy of Research Society on Alcoholism, Alcohol and Alcohol Actions Lecture Series
http://rsoa.org/lectures/about.html
31
32
11
Handout #1
Risk Factors
Dose of alcohol
Pattern of exposure - binge vs chronic
Developmental timing of exposure
Genetic variation
Maternal characteristics
Synergistic reactions with other drugs
Interaction with nutritional variables
Slide courtesy of Research Society on Alcoholism, Alcohol and Alcohol Actions Lecture Series
http://rsoa.org/lectures/about.html
34
FASD Interventions
Pre-natal counseling
Assessment
Infant Stimulation
Teach parent
Special school interventions and
accommodations
Counseling and education for parent
35
Organic disease
Non-organic
Unintentional
Child Neglect
36
12
Handout #1
37
38
Cerebral Palsy
39
13
Handout #1
Cerebral Palsy
Preschool Social
Development
Interactive play
Functions of play
41
Preschool Emotional
Development
Development of initiative
Development of self-control
Development of conscience
Self esteem dependent on others
reactions
42
14
Handout #1
Preschool Cognitive
Development
Egocentric thought
Illogical thinking
Vivid imaginations and magical
thinking
Immature sense of time
Role of cognition in effects of
maltreatment
43
44
Preschooler Language
Development
Pre-operations
Duos
Vocabulary expands
Non-stop talk
Asking questions
Promoting language development
Culture and language
45
15
Handout #1
Preschoolers Physical
Development
Rule of 3s
Cultural influences
Busy, active
46
Preschoolers Sexual
Development
Varying levels and frequency of
sexual behavior
Stereotypic understanding of gender
roles
Havent learned rules of privacy
Understand where babies come
Touch own and others genitals
May masturbate
47
16
Handout #1
ASSESSING SEXUAL
BEHAVIOR
Concerning sexual behavior:
Interferes with other activities
Involves coercion
Causes emotional distress
Is compulsive or anxious
Persists beyond pain
49
Challenging Aspects of
Preschool Development
Normal challenges
Special Problems
50
Working with
Preschool Children
17
Handout #1
Cheryl Part I
Read Cheryl Part I
Discuss and be ready to report on:
What would you ask Ms. Robinson about Cheryls
development?
How and what would you observe in Cheryl to
assess her development?
Where else would you gather additional
information about Cheryls development?
52
Cheryl Part II
Read Cheryl Part II
Discuss and be ready to report:
Treatment Goals
For children traumatized by maltreatment:
54
18
Handout #1
Emotional disturbances
Emotional disturbances associated
with maltreatment in preschoolers:
Reactive Attachment Disorder
Anxiety Disorders
Post Traumatic Stress Disorder
55
School Aged
56
19
Handout #1
58
59
Inappropriate expectations
for responsibilities at home
20
Handout #1
61
Outcomes of Maltreatment
On school performance
On childs behavior and development
On emotional well-being
On relationships with parents and other
adults
On relationships with peers
On ability to be self-directed and
competent
62
Emotional Disturbances
Emotional Disturbances Associated
with Maltreatment:
Affective Disorders
Conduct Disorders
63
21
Handout #1
Remembering
Your Adolescence
64
Adolescent Physical
Development
Growth spurt: girls age 11 14
boys age 13 17
Puberty: girls 11 14
boys 12 - 15
Early vs late puberty
Self conscious
Self image affected by emotional
factors
65
Adolescent Cognitive
Development
Formal operations:
Hypothetical thought
Logical thought
Think about thought
Insight and perspective taking
Systematic problem solving
66
22
Handout #1
67
68
Adolescent Sexual
Development
Cultural expectations regarding
sexuality
Early sexual behavior largely
exploratory
Sexual abuse negatively affects
sexual development
69
23
Handout #1
Moral Development
Punishment/Obedience
(preschoolers)
Self Interested Exchanges
(school aged)
Conventional Morality (teens)
Golden Rule; law and order
70
Emotional Development
Identity
Independence
Cultural variations in:
When to leave home
Role of parent
Home vs. outside responsibilities
71
Adolescent Emotional
Development
72
24
Handout #1
Young Adolescents
Emotional Development
Emotionally labile
Want intense
emotional
experiences
Preoccupied
with faults
73
Middle Adolescents
Emotional Development
Perspective taking examine
others values
Awareness of inconsistencies in
values is threatening
Formulation of personal identity
Self esteem: cognitive and affective
74
Identity Confusion
Sexual Identity
Cultural/Ethnic/Racial Identity
25
Handout #1
77
Adolescent Exercise
Read the case examples
Answer these questions for each teen:
26
Handout #1
Thanks to all
Good luck in
Module VIII!
Remember to take Milestones of Child
Development chart to Module VIII
79
27
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
HANDOUT #2
Introductions
Objectives:
Section II
Objectives:
B.
Section III
Objectives:
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #2
Section IV
Objectives:
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #2
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Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #3
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HANDOUT #3
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #3
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HANDOUT #3
Skill Set #5: Ability to promote and sustain healthy attachments between
children and their families or caregivers
1. Knows the parenting practices that support the development of
positive secure attachments in children
2. Knows the parenting practices that contribute to insecure or
maladaptive attachment in children
3. Knows the behavioral and emotional indicators of maladaptive
attachment in both children and adults
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #3
and
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #4
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HANDOUT #4
new attachments may make this impossible. Adoptive parents must be encouraged to
regularly approach the child in a non-threatening, gentle manner to initiate social interactions.
Parents must be prepared to continue to engage the child in a meaningful and pleasurable
interaction without expecting the child to reciprocate in kind.
Claiming Behaviors
A third means Fahlberg recommends to promote attachment is claiming. Claiming is the
process of assimilating the child into the family and helping the child feel part of the family.
Claiming behaviors also promote the development of entitlement by the parents - the firm
belief that they have a right to parent the child as their own. These activities are symbolic in
that they communicate acceptance, and integration of the child into family life.
Examples of claiming behaviors are as follow. These activities are symbolic in that they
communicate to the child and the world at large that the child is a member of the family.
Having the family picture taken which includes the child and send that picture to
family members that child regularly visits.
Adding the childs name to the mailbox; allowing the child to sign greeting cards;
Sending out announcements to family and friends when the child joins the family;
Including the childs lifebook with other family albums
Teaching the child old family traditions, incorporate traditions the child remembers
from his earlier life into adoptive family traditions, involve the child in developing
new family traditions.
Planting a tree or flower bulbs in the yard, with the child, to celebrate the adoption
and symbolize the planting of the child in a permanent family. Enlist the child to
tend the new plants as they put down roots and flourish
Having the child help plan future vacations, activities, holidays, etc. to
communicate to the child that s/he is a permanent part of the familys future.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #5
Outcomes of FASD
An average IQ of 63, which falls within the mild range of mental retardation
Irritability in infancy
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #5
Specific facial features, including thin upper lip, epicanthal folds, low nasal
bridge, minor ear abnormalities, flat midface. These features often become
less obvious during adolescence.
The degree and type of damage done to the developing fetus depends upon
several factors including which developmental processes were occurring when
the alcohol was ingested, how much was ingested, and whether the drinking
was chronic or binge drinking. Research has shown that even low levels of
alcohol consumption and infrequent binges can damage the developing fetus.
Research has not identified a safe limit for drinking during pregnancy. The
only prudent conclusion is that alcohol can affect the developing brain even a
low exposure levels. Abstinence during pregnancy is the only way to avoid
such effects. Goodlett and West, 1992, p 64-65, found in Streissguth, page
61)
Recommended interventions
Training the parent or caregiver to plan and implement activities that will
address developmental delays and promote healthy development of their
children.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #6
The effects of drug exposure upon children during pregnancy are not completely
understood. What was once believed to be a consistent syndrome of symptoms
known as crack/cocaine exposure to infants and children is now not believed to
be totally attributable to crack/cocaine exposure during pregnancy. While
research indicates that children who are exposed to other stressors in utero often
suffer a variety of developmental difficulties, the specific effects of various illegal
or street drugs are not completely known.
A number of factors known to affect the fetus during pregnancy probably
combine to place the newborn child at risk for a variety of developmental
problems. These factors include cigarettes, marijuana, cocaine, poor prenatal
care and parenting practices, poverty and low socioeconomic status including low
education level and associated social risks, and the risks associated with drugseeking behavior.
Infants
Infants who have been drug exposed during pregnancy may be very
irritable and difficult to soothe. These children are often labeled
disorganized or lacking the ability to self-regulate their emotional states.
At birth and shortly thereafter these children are often identified as stiff
and irritable by caretakers. These patterns are usually short-lived and
seldom continue beyond infancy.
Drug-exposed infants have a tendency to be smaller at birth in weight and
length. They typically catch up to non-exposed children with proper care
and nutrition.
Other symptoms in newborns include gaze aversion; a frowning or
furrowed brow that gives the infant a worried look, motor agitation,
hiccups, spitting up and crying.
Caretakers should receive education and instruction in strategies to soothe
newborns and learn to reduce their stress. Examples of soothing
strategies include providing firm touch, swaddling the infant with arms
close to his/her body, using a pacifier, and vertical rocking. It is often
helpful to reduce the amount of stimulation in the newborns
environment. Finally, it is critical for parents and caretakers to learn to
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #6
read the infants cues, and adjust their interactions with the baby so as
not to overwhelm or irritate the baby.
Treatment
Caretakers of children who are drug exposed should be aware of indicators of
developmental delays and should seek medical, developmental or psychological
assessments for children who exhibit difficulty.
Early intervention services that stimulate cognitive, motor, language and social
development are effective for children with delays caused by drug-exposure.
These services are available through Help Me Grow programs.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #7
Failure to Thrive
Definition
The term "failure to thrive" (FTT) has been used to describe a wide variety of
conditions in which infants fail to achieve age-appropriate weight and height
levels. Block, et al (2005) state that inadequate nutrition and disturbed social
interactions contribute to poor weight gain, delayed development, and abnormal
behavior. The syndrome develops in a significant number of children as a
consequence of child neglect
The one characteristic common to these children is nutritional deficiency. This
can be caused by a number of problems, and is often caused by a combination
of the following factors:
FTT from neglect often causes attachment problems. FTT is often not merely a
feeding problem; it often indicates serious problems in the attachment, especially
disorganized attachment, between the baby and primary caretaker. (Carlson,
2003) However, not every child with FTT has an attachment problem.
Most appear emaciated, pale, and weak; and have little subcutaneous
fat and decreased muscle mass.
The infants are often below their birth weight, indicating weight loss;
or their weight is well below the normal range.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #7
Infants may sleep for longer periods of time than is appropriate for
age.
Parents often show little ability to empathize with their infants; they
often misread or ignore their infant's cues. Their behavior meets their
own needs rather than their infants.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #7
The parent may not realize the child is failing to grow, nor recognize
the lack of weight gain and emaciation.
The parent may notice the child's feeding problems but think they are
the result of vomiting, diarrhea, or other physical illness, rather than
problems in the feeding situation itself. The parent may believe the
child is being adequately fed.
The parent may allow long periods of time to elapse between feedings
because "the baby doesn't appear to be hungry." Apathy and
listlessness that result from low caloric intake are mistaken for the
absence of hunger.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #7
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #8
Infants who have been abused severely, and at an early age, demonstrate
predictable developmental patterns and delays, as follows:
Treatment Interventions
Specialized treatment methods are necessary if we are to help this child. Simply
eliminating the abuse is not enough. Parents and foster caregivers must be
trained to nurture this child in a predictable, measured fashion. "Too much too
soon" can overwhelm the child and have the effect of further closing him off.
As a result, treatment may take months.
Move SLOWLY! Take care to approach the child slowly at all times, and
do not institute too many changes at once.
Read the child's cues to determine his or her needs. When the child
withdraws from an approach, back off, and approach again more slowly or
tentatively. The child needs to become acclimated. There is a fine line
between providing nurturance and overwhelming the child.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #8
Choose times in which to interact with the infant, and keep these times
short at first.
Talk to the child using a soft, affectionate tone of voice. QUIET and
COMFORTING is the rule.
Introduce pleasure into care giving. Any interaction with the child,
including feeding, bathing, and changing clothes, should be performed
gently, allowing the infant to experience normal infant pleasures.
Adequate time should be taken; these activities should not be rushed.
Do not force physical affection. Begin with gentle touching, patting, and
stroking. When holding the child, hold lightly. Cuddling is fine when the
child appears to respond positively by conforming to the adult's body, or
"settling in." Follow the child's cues about physical affection.
After a period of time the child may exhibit such behaviors as thumb
sucking, clinging, other dependent behaviors, frequent crying, stranger
anxiety, separation anxiety, and other signs of social need. These must
be viewed as PROGRESS rather than as problem behaviors.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services, Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #9
Cerebral Palsy
Many persons with cerebral palsy have mixed types. 90% of cerebral palsy is
either spastic, athetoid, or a combination of both.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #9
Failure to achieve head control, or to lift head and chest from a prone
position when the child is on his stomach, in a child older than 5
months.
Failure to reach for objects or to transfer objects from one hand to the
other, in a child older than 7 months.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #9
Persistent use of only one hand when playing with a toy, including
reaching across the body to retrieve an object, rather than reaching
with the arm that is on the same side of midline as the object.
Infants typically use both hands equally for the first 15 months of life.
Good use of hands and arms, but drags legs. While many infants go
through a stage of "G.I. Joe" crawling on their stomachs, failure to
progress to more advanced use of the legs might be indicative of
cerebral palsy.
Treatment Recommendations
Early intervention can increase range of mobility and prevent unnecessary
deterioration of motor abilities.
Early intervention can help children learn and grow in spite of their
physical problems. (More than 50% of children with cerebral palsy have
intellectual potential within the normal range.)
Ongoing physical therapy and proper medical management are necessary.
Developmental assessments should be performed to help determine
treatment needs in all developmental areas.
Special infant stimulation programs can greatly improve motor
development as well as cognitive and social development.
Vision and hearing should be routinely screened and monitored as the
child develops. Cerebral palsy can affect both.
Speech therapy should be provided for children whose motor ability to
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #9
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Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #10
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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HANDOUT #11
Cheryl Part I
Cheryl is five years old. She and her-nine-year old sister were referred to the
public children services agency for neglect when neighbors found her trying to
cross the street, unsupervised at 10:00 PM on a Saturday evening. The
subsequent investigation found that she had been severely, chronically abused,
and occasionally neglected. Her mother was addicted to heroin, and used other
drugs and alcohol as well. Her mother often locked Cheryl up in the closet for
punishment, beat her, and left her alone with her 9-year-old sister when she
went out partying. She has no visible means of support. Neighbors think she
prostitutes herself to earn drug and rent money.
Cheryl and her sister were immediately placed in her aunts (Ms. Robertson)
care. At the shelter-care hearing, mother arrived high, and the agency was
granted temporary custody of both girls, and maintained them at Ms.
Robertsons home.
Ms. Robertson was not surprised that the agency became involved. She stated
that she had been worried about the girls for some time, and that she had kept
them overnight on several occasions, when the older sister would call her for
help. Ms. Robertson had not reported the situation to children services, hoping
to avoid outside intervention.
Ms. Robertson is a single mother, with five children. She scrapes by on her
salary as a nurses aide and child support she receives from her ex- husband.
She stated that she loves both girls immensely, and is prepared to care for them
for as long as it takes.
Adapted with permission from The Field Guide to Child Welfare Volume II,
J.S. Rycus, Ph.D., R.C. Hughes, Ph.D., Child Welfare League of America Press, 1998.
Caseworker Core Module VII: Child Development: Implications for Family-Centered Child
Protective Services,Written by IHS for the Ohio Child Welfare Training Program
FINAL July 2008
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Adapted with permission from The Field Guide to Child Welfare Volume II,
J.S. Rycus, Ph.D., R.C. Hughes, Ph.D., Child Welfare League of America Press, 1998.
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Cheryl Part II
You have completed your first home visit to Ms Robersons home. You spoke
with Ms. Robertson, and engaged Cheryl in some activities such as looking at
books, and coloring in a coloring book. You have gathered the following
information:
Cheryl stays close to her aunt as much as possible, and follows her around
the house.
Cheryl uses immature language, using only simple, short sentences. Her
pronunciation is difficult for you to understand. The aunt can seldom
understand her, although she stated that she is starting to catch on to
Cheryls speech patterns.
Cheryl is physically awkward. She walks pigeon-toed, with a halting gait.
Her hand-eye coordination is poor, and shes always bumping into
things.
Cheryl has night terrors, with screaming and crying, though it seems that
she never fully wakes up from these dreams. It is very difficult to calm
Cheryl during these episodes. Ms. Robertson holds her, and rocks her
until she settles down.
Cheryl had difficulty staying on task when you and she colored in the
coloring book. She was easily distracted, and you noticed that her
coloring marks were haphazard, jagged lines, and that very little of her
coloring was within the lines.
Ms. Robertson explains that Cheryl tries to play with children her own age,
but doesnt know how to play cooperatively, and doesnt indulge in any
pretend play like other children her age. Most of the children in the
neighborhood avoid her.
Cheryl has severe temper tantrums about 5 10 times a day. These
tantrums include hitting, screaming, biting and throwing toys against the
walls. Ms Robertson states, its good shes such a little thing, I can hold
her still, if need be.
These tantrums occur when Cheryl is frustrated, or when she cannot get
her own way. She experiences frustration continually: other children and
most adults cannot understand her most of the time and she is often
snubbed by neighbor children who think she is a baby. Furthermore,
she becomes angry when other children expect her to share her toys and
take turns in games.
Ms Robertson states that when checking on the children before she goes
to bed at night, she often finds Cheryl in her sisters bed. She doesnt
separate them, figuring that Cheryl needs her sister for security.
Adapted with permission from The Field Guide to Child Welfare Volume II,
J.S. Rycus, Ph.D., R.C. Hughes, Ph.D., Child Welfare League of America Press, 1998.
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One the basis of your assessment, what kinds of services would you put in place
for Cheryl? Use the Therapeutic Interventions for Preschool Children as a
resource for this discussion.
How would you help Cheryl and her aunt develop a positive attachment
relationship? Use the handout, Promoting Attachment as a resource for this
discussion.
Adapted with permission from The Field Guide to Child Welfare Volume II,
J.S. Rycus, Ph.D., R.C. Hughes, Ph.D., Child Welfare League of America Press, 1998.
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Therapeutic Interventions
for Pre-School Children
Head Start
Occupational Therapy provides services that help children who have impairments
in fine motor movements.
Physical Therapy provides services that help children who have impairments in
large motor movements.
Occupational and physical therapists are state licensed and provide individual
services to help children improve their fine and large motor control and
movement respectively. Therapists use a variety of exercises, treatment, and
games. Often the treatment is extended at home with exercises. Therapists
often use their treatments to help patients re-gain use of their muscles when
recovering from an injury, surgery or stroke. In children these delays are often
caused by a neurological condition such as cerebral palsy, however, in many
young children the origins of the motor delays are often unknown.
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Speech and Language Therapy. Speech therapy is for children who have
problems with the production of words, such as mispronunciation and stuttering.
Language therapy is for children who have difficulty understanding or processing
what is said to them (i.e.: receptive language disorders); or have difficulty
putting words together, limited vocabulary, or using language in a socially
appropriate way (i.e.: expressive language disorder).
Speech and language therapists are state licensed and certified through the
American Speech and Hearing Association. They conduct speech and language
assessments and develop and implement specific treatment strategies for each
child. Speech therapy may be conducted one-to-one, in a small group, or n the
childs classroom.
Location: Speech therapy is available in facilities for children who have mental
retardation or developmental disabilties, Head Start, Help Me Grow, schools, and
through private providers.
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for the remainder of the day. Programs often have an academic component so
that the child can continue attending school while in treatment.
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Location: Mental health services are located in each county. Smaller counties
often combine with one or more counties to provide mental health services.
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Programs for children with emotional impairments are available, in some form, in
every county. However, the specific services and whether they are administered
through the local Department of Mental Retardation and Developmental Disability
or the local school system, varies from county to county.
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Physical
1. Abused and neglected preschool children may be small in stature, and
show evidence of delayed physical growth.
2. They may be sickly and susceptible to frequent illness; particularly upper
respiratory illness (colds, flu) and digestive upset.
3. They may have poor muscle tone, poor motor coordination, gross and fine
motor clumsiness, awkward gait, or lack of muscle strength.
4. Gross motor play skills may be delayed or absent.
Cognitive
1. Speech may be absent, delayed, or hard to understand. The preschooler
whose receptive language far exceeds expressive language may have
speech delays. Some children do not talk, even though they are able to.
2. The child may not use language to solve problems (Cook, et al 2003).
3. The child may articulate and pronounce poorly, form sentences
incompletely, and use words incorrectly.
4. Cognitive skills may be at the level of a younger child.
5. The child may have an unusually short attention span, a lack of interest in
objects, and an inability to concentrate.
6. The child may have less flexibility and creativity in problem solving tasks
(Cook, et al 2003)
7. Children who have experienced trauma may have conditioned fear
responses when something in their environment (a sight, sound, and
smell) is associated with a sight, sound, smell made during a violent
incident. These may be subtle associations made by the child whose
memory is attuned to the presence of potential danger. This is common in
children who have experienced complex trauma.
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Social
1. When under stress, our bodies secrete stress hormones that prepare us
to fight, flee, or freeze in response to danger or threat of danger. When
children are under chronic stress, such as abuse or neglect, their bodies
become unable to regulate this stress reaction resulting in hyper-arousal
or hyper-sensitivity to perceived danger or threat in their environment.
This has significant social and interpersonal implications for children. For
example, if a traumatized preschooler frequently assumes that other
children intend to harm him, it is difficult for that child to form friendships
and play with other children. Children who are continually poised to fight,
or flee will have difficulty functioning in preschool. This is associated with
complex stress.
2. The child may demonstrate insecure or disorganized attachment;
attachments may be indiscriminate, superficial, or clingy. The child may
show little distress, or may overreact, when separated from caregivers.
The childs reaction to parent may be completely disorganized, or the child
may fear an abusive or terrorizing parent. This is also common in children
who have experienced complex trauma.
3. The child may appear emotionally detached, isolated, and withdrawn from
both adults and peers.
4. Alternately, the child may be more dependent on others for support.
(Cook, et al 2003)
5. The child may demonstrate social immaturity in peer relationships; may
be unable to enter into reciprocal play relationships; may be unable to
take turns, share, or negotiate with peers; or may be overly aggressive,
bossy, controlling, and competitive with peers.
6. The child may prefer solitary or parallel play, or may lack age appropriate
play skills with objects and materials. Imaginative and fantasy play may
be absent. The child may demonstrate an absence of normal interest and
curiosity, and may not actively explore and experiment.
7. The child may have lower frustration tolerance, show more anger, and be
non-compliant.
8. Children may engage in specific, odd behaviors that represent their
attempts to cope in their abusive or neglectful environment. Examples
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include food hoarding, wearing several layers of clothing to bed (to avoid
sexual abuse), or manipulativeness.
Emotional
1. The child may be excessively fearful, may have night terrors, and may
seem to expect danger.
2. The child may show signs of poor self esteem and a lack of confidence.
3. The child may lack impulse control and have little ability to delay
gratification. The child may react to frustration with tantrums and
aggression.
4. The child may have impairments in affect regulation, stress management,
empathy, and pro-social concern for others. (Egeland et al, 1983 and
Vonra et al, 1990, from NCTSN paper).
5. The child may have a bland, flat affect and be emotionally passive and
detached.
6. The child may show an absence of healthy initiative, and often must be
drawn into activities. He may emotionally withdraw and avoid activities.
7. The child may show signs of emotional disturbance including anxiety,
post-traumatic stress disorder, depression, attachment problems,
emotional volatility, self-stimulating behaviors such as rocking, or head
banging, enuresis or encopresis, or thumb sucking, or Reactive
Attachment disorder.
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Description
Reactive Attachment Disorder (RAD) is a diagnostic label described in the DSMIV and refers to a disorder usually first diagnosed in infancy or early childhood.
As such, this disorder has specific diagnostic criteria. The disorder does not
cover many of the behavioral concerns that may be observed when the
attachment process is disrupted by separations, illnesses and disability on the
part of the caretaker, or even by disturbed parenting practices. While these
environmental conditions are often precursors to Reactive Attachment Disorder,
the diagnosis of Reactive Attachment Disorder identifies criteria for both the
behavioral characteristics and problematic environmental precursors necessary
for making the diagnosis this diagnosis.
The DSM-IV recognizes two general types of behavioral manifestations of
Reactive Attachment Disorder. The Inhibited Type is characterized by a child
who exhibits a "persistent failure to initiate or respond in a developmentally
appropriate fashion to most social interactions, as manifest by excessively
inhibited, hyper vigilant, or highly ambivalent and contradictory responses (e.g.,
the child may respond to caregivers with a mixture of approach, avoidance, and
resistance to comforting, or may exhibit frozen watchfulness)." Diagnostic
criteria for the Disinhibited Type describe a child with "diffuse attachments as
manifest by indiscriminate sociability with marked inability to exhibit appropriate
selective attachments (e.g., excessive familiarity with relative strangers or lack of
selectivity and choice of attachment figures)." (DSM IV)
In either type, there must be evidence of "markedly disturbed and
developmentally inappropriate social relatedness in most contexts, beginning
before age 5 years, (DSM IV) It is important to note that the criteria for
disturbed attachment includes the following:
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The DSM-IV states, "by definition, the condition is associated with grossly
pathological care that may take the form of persistent disregard of the child's
basic emotional needs for comfort, stimulation, and affection; persistent
disregard of the child's basic physical needs; or repeated changes of primary
caregivers that prevent formation of stable attachments.
As children mature into adolescence Reactive Attachment Disorder can have
many expressions. With the Disinhibited Type the hallmark criteria include
diffuse, indiscriminate sociability and difficulty making appropriate selective
attachments. Interference with intimate social functioning is at the core of this
disorder. Disturbances of conduct, oppositional behavior, and diffuse
manifestation of disinhibition or impulsive behaviors are not core symptoms
according to the DSM-IV.
Treatment
Attachment therapy is any therapy that attempts to repair damaged attachment
as the result of trauma. It addresses relationship issues between the child and
his parents.
In the past, attachment therapy included a variety of coercive methods to force
the child to submit to the will of the parents, such as forcibly holding the child for
long periods of time, and enforcing eye contact. These methods have since been
discredited by several professional organizations (American Psychiatric
Association, American Academy of Child And Adolescent Psychiatry, American
Professional Society on the Abuse of Children).
The field of attachment therapy has moved away from these techniques, and
now promotes the use of a variety of techniques to help parents become attuned
to their children; and to help children learn to regulate their emotions and
behavior, and come to terms with trauma that may have occurred in their past.
Appropriate treatment emphasizes short term, specific counseling to provide
stability and improve the quality of the parent-child relationship. The focus is on
providing a stable environment for the child, and taking calm, sensitive, nonintrusive, non-threatening, patient, predictable, and nurturing approach to
parenting. This approach emphasizes teaching positive parenting skills, rather
than the childs pathology. (Chaffin, 2006)
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When referring children therapy for attachment problems, workers should clarify
which strategies will be used. Furthermore, caseworkers should seek guidance
from their supervisors if the therapist suggests using any coercive strategies.
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Anxiety Disorder
Description
Anxiety disorders refer to a cluster of disorders whose primary features include
excessive fearfulness and stress response. In general, the term anxiety disorder
describes an excessively fearful or stressful response to a perceived threat in the
present environment or to anticipate future threat. Anxiety Disorders are
relatively common among the mental disorders.
Anxiety disorders usually include strong somatic symptoms, such as stomach
aches, headaches, nervousness and problems with sleeping and eating that can
be quite uncomfortable for the child.
The DSM-IV indicates that children can be diagnosed with the following anxiety
disorders:
panic disorder with agoraphobia,
panic disorder without agoraphobia,
acute stress disorder,
generalized anxiety disorder,
post-traumatic stress disorder,
adjustment disorder with anxiety,
social phobia,
specific phobia, and
obsessive-compulsive disorder.
Additionally, all forms of anxiety disorders involve the loss of functioning in
important domains of life, such as school, social functioning and peer
relationships.
As you can see by the number of DSM-IV diagnoses, anxiety can have many
presentations. Human adaptive responses to severe stress vary widely and, as in
all mental disorders, the outcome depends upon the nature and severity of the
environmental stressors and the heritable characteristics of the person
experiencing them. However, child abuse and neglect increase childrens
vulnerability to anxiety disorders. Likewise, children who are exposed to domestic
violence may be more likely to develop an anxiety disorder.
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anxiety when the child encounters that smell later, whether or not the
perpetrator is present.
Long-term effects
People who have a history of severe stress as children remain vulnerable into
adulthood, even when they recover to normal functioning. If they are subject to
another trauma or experience a severe loss they remain more likely to have a
catastrophic response (major depression, traumatic stress response) to the later
event.
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Rates of PTSD identified in child and adult survivors of violence and disasters
vary widely. For example, estimates range from 2 percent after a natural disaster
(tornado), to 28 percent after an episode of terrorism (mass shooting), and 29
percent after a plane crash.13
The disorder may arise weeks or months after the traumatic event. PTSD may
resolve itself without treatment, but some form of therapy by a mental health
professional is often required in order for healing to occur. Fortunately, it is more
common for traumatized individuals to have some of the symptoms of PTSD than
to develop the full-blown disorder.14
As noted above, people differ in their vulnerability to PTSD, and the source of
this difference is not known in its entirety. Researchers have identified factors
that interact to influence vulnerability to developing PTSD. These factors include:
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Research has shown that PTSD clearly alters a number of fundamental brain
mechanisms. Abnormal levels of brain chemicals that affect coping behavior,
learning, and memory have been detected among people with the disorder. In
addition, recent imaging studies have discovered altered metabolism and blood
flow in the brain as well as structural brain changes in people with PTSD.15-19
Treatment
People with PTSD are treated with specialized forms of psychotherapy and
sometimes with medications or a combination of the two. One of the forms of
psychotherapy shown to be effective is Cognitive Behavioral Therapy (CBT). In
CBT, the patient is taught methods of overcoming anxiety or depression and
modifying undesirable behaviors such avoiding reminders of the traumatic event.
The therapist helps the patient examine and re-evaluate beliefs that are
interfering with healing, such as the belief that the traumatic event will happen
again. Children who undergo CBT are taught to avoid "catastrophizing." For
example, they are reassured that dark clouds do not necessarily mean another
hurricane, that the fact that someone is angry doesn't necessarily mean that
another shooting is imminent, etc. Play therapy and art therapy also can help
younger children to remember the traumatic event safely and express their
feelings about it. Other forms of psychotherapy that have helped persons with
PTSD include group and exposure therapy. A reasonable period of time for
treatment of PTSD is 6 to 12 weeks with occasional follow-up sessions, but
treatment may be longer depending on a patient's particular circumstances.
Research has shown that support from family and friends can be an important
part of recovery.
There has been a good deal of research on the use of medications for adults with
PTSD, including research on the formation of emotionally-charged memories and
medications that may help block the development of symptoms.20-22 Medications
appear to be useful in reducing overwhelming symptoms of arousal (such as
sleep disturbances and an exaggerated startle reflex), intrusive thoughts, and
avoidance; reducing accompanying conditions such as depression and panic; and
improving impulse control and related behavioral problems. Research is just
beginning on the use of medications to treat PTSD in children and adolescents.
There is accumulating empirical evidence that trauma or grief-focused
psychotherapy and selected pharmacologic interventions can be effective in
alleviating PTSD symptoms and in addressing co-occurring depression.23-26
However, more medication treatment research is needed.
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Recent Research
The National Institute of Mental Health (NIMH), a part of the Federal
Government's National Institutes of Health, supports research on the brain and a
wide range of mental disorders, including PTSD and related conditions. The
Department of Veterans Affairs also conducts research in this area with adults
and their family members.
Recent research findings include:
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PTSD in Children
For children 5 years of age and younger, typical reactions can include a fear of
being separated from the parent, crying, whimpering, screaming, immobility
and/or aimless motion, trembling, frightened facial expressions and excessive
clinging. Parents may also notice children returning to behaviors exhibited at
earlier ages (these are called regressive behaviors), such as thumb-sucking,
bedwetting, and fear of darkness. Children in this age bracket tend to be strongly
affected by the parents' reactions to the traumatic event.
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DEPRESSION
Description
Affective disorders, or mood disorders, can appear in children and adolescents as
well as adults. The Depressive disorders are one of the mood disorders and
include Major Depression, Bipolar Disorder, and Dysthymic Disorder. Childhood
depression can affect a child's cognitive functioning, emotional functioning,
behavior and body functioning.
As with many disorders, there appear to be genetic links between generations
that result in vulnerabilities for acquiring depressive disorders. Children of
parents who have affective disorders are at increased risk for acquiring affective
disorders themselves. Environmental factors including child abuse and serious
neglect are correlated with children exhibiting depressive symptoms.
Symptoms
In childhood, symptoms of depression can appear somewhat different from
symptoms in adults. Irritability is often more prominent in children as opposed to
the noticeable sadness that may be present in adults. In adolescents a pervasive
lethargy may signal depression more than in adults (but not always). Depressive
symptoms in children and adolescents may include*:
hopelessness, boredom
reckless behavior
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Bipolar disorder
Bipolar disorder is a mood disorder that often presents some early symptoms
in childhood and adolescence. Bipolar disorder is a serious disorder that can
persist through adulthood. This disorder can include fluctuations in mood and
energy levels and disturbances in thought patterns that impair functioning in
family relationships, academics and peer relationships. Treatment of bipolar
disorder is often different from treatment for other forms of depression. Early
detection of bipolar disorder is important because of the differing treatments
bipolar disorder requires. However, symptoms associated with early onset
bipolar disorder can be difficult to differentiate from other childhood
disorders. The National Institute for Mental Health recommends that:
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Conduct Disorder
Description
According to the DSM-IV, essential features of Conduct Disorder are "a repetitive
and persistent pattern of behavior in which the basic rights of others or major
age-appropriate societal norms or rules are violated. It is important to
differentiate occasional emotional outbursts that may be reactions to specific
events from Conduct Disorders. The differentiating factor is that a person with
conduct disorder has a consistent, persistent pattern of these behaviors.
These behaviors fall into one of four general categories:
Aggression to people and animals
Destruction of property
Deceitfulness or theft
Serious violations of rules
According to the DSM-IV, Conduct Disorder is generally diagnosed as one of two
types: the "Childhood Onset Type", and the "Adolescent Onset Type," depending
on when the behaviors began to emerge.
Gender Differences
Prevalence rates for Conduct Disorder are higher for males than females.
The expression of Conduct Disorder behaviors is different between genders.
Males tend to exhibit more physically aggressive behaviors such as physical
fights, use of weapons to physically harm others and physical cruelty. Females
with Conduct Disorder are more likely to exhibit aggression through social
intimidation, social cruelty, running away, staying out overnight despite parental
prohibitions, truancy, or other nonphysical behavioral expressions.
Causes
Research indicates that Conduct-Disorder related behaviors may be caused by
either environmental conditions or genetic pre-disposition, or a combination of
both.
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Parental History
Parents with a history of alcohol dependence, mood disorders,
Schizophrenia, and biological parents with a history of Attention Deficit
Hyperactivity Disorder or Conduct Disorder have an increased chance
of having children with Conduct Disorder.
Environmental Influences
Children who have been physically or sexually abused are more likely
to exhibit aggressive, antisocial, or conduct-related behavior problems.
Parents who use coercive means to manage children's behavior are
more likely to have children who display externalizing behaviors (i.e.:
aggression, acting out, disruptive behavior in school) and coercive
behaviors.
Parental neglect is also a risk factor for the development of
externalizing behaviors including conduct disorder symptoms.
Associated Conditions
There are several known associated correlates to the development of Conduct
Disorder. Although they are distinct disorders, Oppositional Defiant Disorder is
frequently a precursor to Conduct Disorder. Attention Deficit Hyperactivity
Disorder is also frequently found in histories of adolescents with Conduct
Disorder. Persons with Conduct Disorder have a higher than expected chance of
having a co-existing learning disability.
Treatment
Early intervention is very important for parents of children with aggressive,
destructive, and defiant behavior. Conduct problems often persist into
adolescence and beyond, especially when serious symptoms appear in childhood.
Parent training specifically designed for defiant and coercive behavior problems
can be an effective intervention. It is important that therapy strategies be
adaptable to the child's natural environment. Therefore engaging parents and
school staff in learning effective strategies for managing the child's behaviors is
often critical to success. Strategies could include providing a stable environment
with predictable consequences for behavior, and anger management.
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Laurie
Laurie is nine. She is in her third foster home after having disrupted from an
adoption. You are her caseworker. The case was recently transferred to you,
and you have just met Laurie. You know her foster mother, Jean Wilson,
however. When you called Jean to tell her you had been assigned to the case,
she said "Boy, am I glad to hear from you! I don't know what to do with this
kid." Jean also told you Laurie's teacher had called and was having difficulty with
Laurie in school.
You have gathered the following information from the case record, previous
foster families, Jean, and the teacher. It is your job to develop a case plan for
Laurie and to help Jean and the teacher manage Laurie in a way that helps
resolve her problem, preserves the placement, and promotes more healthy
development.
Laurie was born to a l7-year old girl who abandoned her at a neighbor's when
Laurie was one year old. At that time she was functioning at a six to eight
month old developmental level. There was no evidence of abuse, but it
appeared Laurie had been chronically and severely neglected. She was placed in
a foster home.
During the following year in foster care, she developed well and eventually
closed most of the gaps between her chronological age and her developmental
age. She was placed for adoption at age two.
The adoption disrupted a year and a half ago because the adoptive parents felt
they could "never really get close to Laurie." She has lived in three foster homes
since that time. The first foster family requested that Laurie be removed after
five months. Her second foster family moved out of state, but the placement
was not going well and was expected to disrupt. Jean agreed to take Laurie to
stabilize placement. Jean is a flexible, affectionate, and patient woman who has
worked with difficult children in the past. However, "something about Laurie"
confounds her.
Laurie exhibits the following behavior patterns.
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Laurie does not sleep well. She cries out in her sleep, and sleepwalks.
Laurie is eneuretic and wets the bed several times a week. She often
"forgets" to change her bedding, and will pull the covers over the wet
sheets.
She loves to help Jean in the kitchen, but is not reliable about completing
her routine chores. She wants to be involved in activities, but is easily
discouraged and gives up when they don't go exactly right. She seems to
lose interest in many activities quickly.
She has low frustration tolerance. When confronted by events that would
be only mildly annoying to most 9-year olds, Laurie becomes totally
enraged and throws screaming tantrums, slams doors, throws objects,
and kicks furniture and people.
Laurie takes other people's belongings and hides them, and then forcefully
denies having taken them. Jean thinks Laurie may be taking change off
her husband's dresser.
Jean says Laurie completes her school papers, but they are often
carelessly done, messy, and at times, unreadable. She is below grade
level in most subjects, and doesn't like school. She does well in reading.
The school psychologist says she has average intellectual potential, with a
measured full-scale IQ of 102. He noted no learning disabilities or
attention deficit disorder.
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At recess, Laurie prefers to play with the first grade children. She can be
bossy and argumentative with them. She does not get along with her
classmates, who see her as a pest and "weird." She is always chosen last
by classmates to be on a team, and the children often complain to the
teacher that "she'll just mess things up for us."
The teacher has told Jean that "Laurie just seems to need more love."
The teacher reports that Laurie has told her many times how the foster
parents seem to prefer their own children to her. Once she complained
that everyone in the family had been given new sweatshirts except her.
The teacher responded by buying Laurie a sweatshirt. Jean later told the
teacher that none of the children had been bought sweatshirts, and that
Laurie was lying to her.
Discussion Questions
l) Assess Laurie's development in all four domains. How do her behaviors
reflect developmental delays and unresolved or poorly resolved
developmental issues?
2) How would you suggest that Jean deal with the following problems? How
would you explain why Laurie has these behavior problems? Remember,
you want to help Laurie develop more normally and acquire ageappropriate skills at the same time you are managing her behavior. You
also want to support Jean and her family and help to preserve the
placement.
Hoarding food
Bed wetting
Stealing, taking other family members' belongings
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FINAL July 2008
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Francie
History
Francie was arrested with a group of other kids at midnight, driving 80 MPH on
the freeway. All had been drinking, and several marijuana joints were found in
the van. Prior to the situation in the van, Francie had been truant from home for
several weeks, and her mother had no idea where she was. Francie was taken
to the detention center after her arrest, and at the juvenile court hearing the
next day, the children services agency was given protective supervision, and
Francie returned to her mothers home.
Francie has lived with her mother on and off since birth. She never knew her
father. Her mother has lived on public assistance and minimum wage jobs since
Francie's birth. She and her sisters, aged 12 and 10 all have different fathers.
Francie's mother has lived with several men since her birth, some of whom beat
her. She has never had a stable marital relationship. She has been arrested for
prostitution.
Francie has been cared for on and off by neighbors, relatives, and licensed foster
homes. Profound neglect, disorganization, and physical deprivation
characterized her early years. It was suspected that her mother's current
boyfriend sexually fondled her when she was 10, but there was never any proof
and the mother broke up with the boyfriend. Her mother abandoned the
children and moved to California with a man she met in a bar when Francie was
5, and returned when she was 6. Francie has been chronically truant from
school.
Characteristics
Francie feels totally victimized by life's events. She feels she no control over her
world or people in it. She does not understand how her behavior has any affect
on other people, or on what happens to her. When bad things happen, it's the
other person's fault. She is baffled when people try to assign blame to her. She
also sees other peoples actions as arbitrary. She has no awareness of rules or
of a structure to the world.
She is very impulsive. She cannot tolerate frustration, and has no ability to delay
gratification. She takes what she wants, fights when she's mad, runs away when
she's afraid, and tantrums when cornered. She is easily frustrated by small
stresses.
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She is totally egocentric. There is only one perspective from which to assess any
event: her own simplistic view. If things go her way, she feels good. If things
don't go her way, she gets mad. The sum total of life revolves around how she
feels, what she wants, her concerns and needs.
Francie displays a kind of "bottomless pit" dependency. She attempts to use all
relationships for gratification of her immediate needs. She is transparently
insincere, and makes clumsy, insincere efforts to flatter or please other people in
order to get what she wants. She doesn't get emotionally involved with people
beyond trying to meet her needs.
Her relationships with people are limited and very shallow, and without
continuity. Her "best friend" could be someone she met 3 days (or 3 hours)
earlier. As long as people are nice to her, they are "friends." If they withhold
what she wants, they are "mean." It is entirely possible for Francie to like you
one minute and hate you 30 seconds later, depending on whether you've been
"nice" or "mean" to her. If you're "mean" enough she'll abandon you, until
you're nice to her again. She has no ability to take other people's perspectives;
she has no idea that other people have feelings, and doesnt understand what
those feelings are. Therefore, she interprets other people's behavior in a very
concrete and egocentric fashion.
Because she has no understanding of rules or the feelings of others, she doesn't
understand what other people expect of her unless it is spelled out in crystal
clear, concrete, behavioral terms. "Please be considerate" is meaningless to her.
She does understand, "Pick up your clothes and put them in the basket".
She has no ability to think about or plan for the future. Her life exists in the
present moment, and is dominated by getting her own immediate needs met.
She feels other people should take care of her. In spite of feeling a victim, she
has grandiose ideas about how wonderful things will be when she's l8 and "on
her own." She has no conception of how this will happen, however.
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Terry
Terry is 16. He was arrested with a group of other kids at midnight, driving 80
MPH on the freeway. All had been drinking, and several marijuana joints were
found in the van He lives in a run-down house with his stepfather and a mentally
retarded uncle. Juvenile court ordered protective supervision of Terry a year ago
when after he had broken into a neighbors garage. The agency has had a case
open on him ever since. Terry had been truant from home for several weeks.
His step-father didn't know where he was. Terry attends school sporadically.
His stepfather works a job that often requires that he travel out of town. When
he is gone, Terry does what he pleases. At the juvenile court hearing after his
arrest, Terry was placed in the custody of childrens services.
History
Terry's mother was married twice. Her first husband was Terry's biological
father. His stepfather and his mother were married when Terry was six, about a
year after the divorce. Terry had been close to his father. After the divorce, his
father remarried and left the state. At the time of the divorce, he promised that
Terry could visit him any time he wanted. However, he has not communicated
with Terry since. Terry's mother left his stepfather many times during their
marriage to live with other men, always returning when things didn't work out.
She finally died of a drug overdose when he was 12.
Terry was a difficult child who wanted to have his own way. He and his
stepfather have been in constant conflict since his mother's death. Terry thinks
his stepfather is a "wimp" who lets people take advantage of him.
Characteristics
Terry likes himself. He sees himself as unique. He thinks that life is a game,
and he feels great when he can beat it. Nobody in his family ever figured out
how to "make it." He thinks he has, and claims it isn't hard. "Most people are
pretty stupid," he says. "You can get what you want, if you're good enough."
He sets up power struggles with adults in authority, and loves it when he wins.
He says it gives him a real rush. He's in charge.
He was in the car with the other kids because "I figured since they had the
joints, they could probably get some coke. I was about ready to score, too,
when that damned police car pulled us over. We wouldn't have gotten caught if
I'd been driving."
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Terry is a manipulator. He approaches life by trying to figure out the rules of the
game and then manipulates better than others. He figures you have to, or else
others will "use you and take advantage of you. You have to be better than
them." He's an expert at conning and conforming. He can be charming and
cooperative, or can work a formula to get around you, depending on which
strategy will best get him what he wants. He makes a good first impression, but
people are quickly alienated when they realize his superficiality and lack of
sincerity. He doesn't understand that conning and conforming are inappropriate
and unproductive ways of relating to people.
Despite his ability to manipulate, he has a very circumscribed understanding of
other people. Terry probably had the basic cognitive capabilities for insightful
social interaction. However, he no longer has the capability or insight to
recognize unselfish or cooperative motivation in others. He doesn't consider
other people's feelings. He denies having any himself.
He has no close friends. He says he doesn't need them; hes perfectly capable of
taking care of himself. He "doesn't have to depend on nobody!"
He claims he doesn't miss his mother. He says he was probably upset when she
died, but got over it quickly. He doesn't remember much about his real Dad.
He doesn't think he was sad for long after his Dad left. He doesn't remember,
but "I was a pretty tough little kid. It probably didn't bother me." He creates an
image of invulnerability and indifference.
He doesn't think being arrested was any big deal. He claims, "I'll be out of here
soon, no big deal." He thinks it was pure bad luck they were arrested. He
doesn't see himself as having any problems.
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Kathy
Kathy is 16. She was arrested with a group of other kids at midnight in a van
driving 80 MPH on the freeway. All the kids had been drinking, and several
marijuana joints were found in the van. Kathy insisted she didn't know there
were drugs in the van. She had been standing on the corner with some kids
from school when "this kid came by in a car and asked if we wanted to go for a
ride." Kathy said she hesitated, but went along because she didn't want her
friends to think she was weird. Juvenile court gave the children services agency
protective supervision of Kathy.
History
Kathy lives with her parents and two younger brothers and a younger sister. Her
father is a minister, her mother a homemaker who is active in the church as the
minister's wife.
Kathy's mother is a quiet, unassuming woman. She has devoted her life to
serving others. She spends several evenings a week with church-related
activities. Kathy's father cares for the children these evenings, unless he too has
church related obligations. Kathy then has the responsibility of caring for the
other children.
When Kathy was 12, her father began finding excuses to come into the
bathroom when she was bathing and watch her out of the corner of his eye.
Kathy would ask him to leave, but he repeatedly told her there was nothing
wrong with his being there; after all, he was her father, and he'd seen her naked
all her life. About six months later he began going into her bedroom at night.
He began by fondling her, moved to finger penetration, and finally began
intercourse when Kathy was 14. Her father told her that God thought the human
body was beautiful, and that the relationship between parents and children was
the most sacred of all human relationships. However, he said, other people who
weren't as close to God wouldn't understand, and if she ever said anything to
anyone about their "special relationship," he would be banned from the church,
and they would lose their home and the family would break apart.
Kathy didn't disclose the abuse until she was placed in detention overnight, and
disclosed to one of the staff members there. Kathy began to cry and told the
worker how ashamed she was. Despite what her father had told her, she knew
that what they had been doing was wrong. She had seen a TV program on
incest, and realized what was happening. She had wanted to tell her mother,
but her mother had also watched the TV program and blamed the child in the
program indicating that the child was "a bad girl- she must have asked for
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trouble." Kathy knew her mother would think her bad and blame her, and she
was ashamed that maybe her mother was right. After all, she didn't fight her
father. She said she was afraid her father would lose his job if she told anyone.
She was sure nobody would forgive her, now that she really had told. She
guessed it didn't matter because nobody would ever want to date her now
anyway.
Kathy appeared to be anxious and very depressed. She claimed not to be a
chronic user of drugs or alcohol. She said she did go out a lot with her friends to
get away from her father. It made her Dad very angry, but she couldn't help it.
She became upset" when she stayed at home; her stomach ached, she had
headaches, and sometimes she threw up. She felt better if she was out of the
house "where there is some fresh air."
She told the worker she wished things could be different. She despaired of this
being possible. A check of police records showed that Kathy had been arrested
twice previously with groups of teens who were out late drinking, but charges
were never filed against her. Teachers reported occasional angry outbursts at
school between Kathy and other students, with Kathy apparently starting
arguments over minor issues. Her teachers liked her but felt her to be
withdrawn and pensive. A school counselor said Kathy would "wander in" to
chat frequently, but seemed reluctant to talk about her private life. Kathy also
seemed to work hard to prove that she was a good student, apologizing
profusely when she didn't do well on school tests.
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Lee
Lee is 16. He was arrested with a group of other kids at midnight, driving 80
MPH on the freeway. All had been drinking, and several marijuana joints were
found in the van. Lee had been truant from home on and off for several weeks;
his mother didn't know where he was, but thought he had perhaps gone to visit
a 20-year old "friend," a man Lee had met a few weeks earlier in the next town.
She was worried about Lees whereabouts and called the police, who notified the
children's service agency. At the juvenile court hearing after his arrest, the
children services agency was given protective supervision of Lee.
History
Lee was the 4th of 6 children, born and raised on a farm. His family had enough
money to get by, but they rarely had extra. Lee's father was an alcoholic and
most nights would drink himself into a stupor. Occasionally he would be verbally
abusive, but there is no evidence of physical abuse. Two years ago, Lee's father
died of alcohol-related illness. Lee's mother couldn't manage the farm and
moved with Lee and two younger siblings into the city. She survives on a
minimum-wage job and food stamps.
Characteristics
Lee is a quiet, generally cooperative youth. He is easy to get along with, almost
to the point of over-compliance and passivity. He readily agrees with others and
conforms quickly to their demands, particularly when he views them to be in
power. He typically over-estimates other people's power and sees himself as
having almost none. He has very poor self-esteem and feels entirely inadequate
in comparison to people around him. To adults, he appears helpless and in need
of protection.
He is dependent on others to meet his needs. He craves social approval and
acceptance. He yields quickly to peer group pressure when with peers, and to
adult authority when he's with adults. He will comply with whoever is in control
at the moment in order to be accepted and viewed in a positive light.
His thinking ability is very concrete, and he views the world in simplistic,
concrete terms. He has limited perspective-taking ability. He knows that people
are different, but he evaluates them based upon observable behaviors, and he
has no insight into other people's feelings. His mother is "nice, she cooks good
meals." His father "was a drunk and worked a farm." He is "friendly, not so
good in school." He knows his mother gets mad when he runs away from home,
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but he really likes to be with Tom, his 20-year old friend. Tom is "cool - he has
his own car and rents a neat apartment."
He knows right from wrong; he knows it's wrong to skip school, and it's good to
go to church and sit quietly. He shouldn't fail in school, and he should get a
good job when he grows up. It's wrong to hurt other people. It's important to
be nice. He doesn't like "being in trouble" at all.
He understands his own feelings in concrete terms. He knows he gets mad,
sometimes he's happy, sometimes he's sad. He doesn't think it bothers anyone
when he gets mad. He is impulsive. He knows he shouldn't run away, and he
should be in school. He should get better grades. But none of this changes his
behavior. He was in the van with the other kids because "it seemed like it would
be fun and all the others were going."
He is viewed by peers as a "tag-along" and peers often use him. He will do
whatever he's told, because he craves social acceptance. He is only marginally
accepted, however, and at times is scapegoated.
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